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USER GUIDE

STOP SMOKING SERVICE (ELECTRONIC MONITORING & CLAIM SYSTEM)

Updated May 2017 v 3.6

StopSmokingNI User Guide v 3.6

© Public Health Agency

Contents Contact Details - PHA Locality Tobacco Control Teams .............................................................................................. 3

Before Getting Started ................................................................................................................................................ 4

Initial Assessment Form .............................................................................................................................................. 5

Client Declaration Form .............................................................................................................................................. 5

Setting up a StopSmokingNI Username Login ............................................................................................................ 6

Creating a New Password on Login (When Blank) ...................................................................................................... 8

Provider Menu - Change a Password.......................................................................................................................... 9

Logging into StopSmokingNI (Username & Password) ............................................................................................. 10

Reading System Announcements within StopSmokingNI .......................................................................................... 12

StopSmokingNI Service Provider and Specialist Status ............................................................................................ 13

Registering as a New Specialist ................................................................................................................................ 14

Associating your Specialist Account with another Provider........................................................................................ 16

Editing Specialist Details ........................................................................................................................................... 17

The ‘Provider Dashboard’ ......................................................................................................................................... 18

Contact Coordinator Menu ........................................................................................................................................ 19

New Client - Postcode .............................................................................................................................................. 20

Client Details: Form 1 .............................................................................................................................................. 21

Completing a Client Details: Form 1 .......................................................................................................................... 21

Client Declaration Form ............................................................................................................................................ 22

Viewing-Editing Client Details (Form 1) ..................................................................................................................... 23

If required you can edit client details once submitted. ............................................................................................... 23

Assign Clients to a Specialist .................................................................................................................................... 24

Moving Clients to another Specialist ......................................................................................................................... 25

Switch Specialist ....................................................................................................................................................... 26

Follows-Up: Forms 2: 4 weeks Form 3: 52 weeks ..................................................................................................... 27

Reporting Inaccurate Data Submitted on a Follow-Up Form ...................................................................................... 27

Claiming for Payment................................................................................................................................................ 29

Provider Menu - Outstanding Claims ........................................................................................................................ 29

Previous Claims ........................................................................................................................................................ 31

Outstanding Follow Ups ............................................................................................................................................ 32

Outstanding Follow-ups – Quality Standards ............................................................................................................ 32

Anonymous Monitoring ............................................................................................................................................. 34

Logout ...................................................................................................................................................................... 35

Possible Problems .................................................................................................................................................... 36

Notes on Completing Stop Smoking Monitoring Forms ............................................................................................. 37

Client Declaration Form ............................................................................................................................................ 37

Client Details, Form 1 ............................................................................................................................................... 37

4-Week Follow-up, Form 2 ........................................................................................................................................ 41

52-Week Follow-up, Form 3 ...................................................................................................................................... 42

Part B (Equality Monitoring) ...................................................................................................................................... 43



Contact Details - PHA Locality Tobacco Control Team s

The Public Health Agency (PHA) Tobacco Control Administrator is your first point of contact in relation to issues with the monitoring website (www.StopSmokingNI.com). This includes submission of electronic claims, queries around payments, purchasing of CO monitors and reimbursement for calibration, and the supply of further forms/materials.

The Senior Officer/Manager can advise and assist you in terms of queries around service delivery, requirements and contract-related issues.

Please note that queries regarding specific NRT products should be directed to your local contact person within the Integrated Care department of the Health and Social Care Board and as a general rule you should follow the Product Information Leaflet that is provided with a particular product.

Public Health Agency Address Telephone

Belfast Area Linum Chambers

2 Bedford Square Belfast BT2 7ES

028 9536 1688

Northern Area County Hall

182 Galgorm Road

Ballymena BT42 1QB

028 9536 2874

South Eastern Area Linum Chambers

2 Bedford Square Belfast BT2 7ES

028 9536 1688

Western Area Gransha Park House

15 Gransha Park

Clooney Road

L’Derry, BT47 6FN

028 9536 1102

Southern Area Tower Hill

Armagh, BT61 9DR

028 9536 3530



Before Getting Started

Each time a client enters your stop smoking service you need to:

• Log onto your StopSmokingNI account (details of how to do this are contained later in this guide).

• Print and complete (in hard copy only) a Client Declaration Form . This form is available within StopSmokingNI. Alternatively, print a hard copy from this guide. Once completed, this form must be retained by the service provider for a period of 7 years.

• An Initial Assessment Form is included in this User Guide. This form is not available within StopSmokingNI. You can use this form for clients who wish to enrol in the stop smoking service. It will help you to access their level of motivation.

• For every client enrolled, additional monitoring data is required. This can be recorded in StopSmokingNI. This includes:

o Client details - Form 1

o 4 week follow up - Form 2

o 52 week follow up - Form 3

• If preferred, Service Providers can complete the additional monitoring forms manually, adding them to StopSmokingNI at the end of each month.



Initial Assessment Form

To assess a client’s suitability for the Stop Smoking service an ‘Initial Assessment Form’ can be used. This form is not available within StopSmokingNI.



Client Declaration Form

Service providers are required to complete and retain a ‘Client Declaration Form ’ for every client enrolled within StopSmokingNI. A hard copy must be retained, by the Provide, for a period of seven years. Whilst Client Declaration Forms can be printed from StopSmokingNI they will not be stored within the system.



Setting up a StopSmokingNI Username Login

PHA will create your Username, enabling you to access the StopSmokingNI website. You cannot logon without a Username.

Contact your local Tobacco Control Administrator for your Username (see section Contact Details by PHA Locality Tobacco Control Teams for area details).

Once allocated a Username:

• Type or paste this URL into your Internet Browser www.stopsmokingni.com

• Enter in your User Name

• Leave the Password box blank

• Click the Login button

• From the ‘Please Set a Password’ dialog box select: Click here to Set your Password



Creating a New Password on Login (When Blank)

From the Change Password screen add the following information:

• New Password : enter a password you will remember

• Confirm Password (re-enter the password just entered)

• Click ‘Change Password ’

• A submission message will confirm that your Password has been changed successfully

• To ensure that you are following the steps in the order they are set out in this user guide, it is important that you now ‘Logout’.

�� You are now ready to log on for the first time using your username and password.

�� If you forget your password at any stage, please contact your Tobacco Control Administrator (details of which can be found in section Contact Details by PHA Locality Tobacco Control Teams). They will clear your password in order for you to set a new one by following the steps in this section.



Provider Menu - Change a Password

• Select ‘Change Password ’

• Complete the 3 text boxes provided:

o Current Password

o New Password

o Confirm New Password

o Select ‘Change Password ’

• A submission message will confirm that your Password has been changed successfully

• Select ‘Click here to continue …’



Logging into StopSmokingNI (Username & Password)

After your initial login, where you created a password, you will then access StopSmokingNI using both your Username and Password.

• Type or paste this URL into your Internet Browser www.stopsmokingni.com

• Type in your username and password and click Login

• If you have any problems please Contact your local Tobacco Control Administrator.



StopSmokingNI Announcements

• PHA coordinators post System Announcements. This screen allows you to read all important announcements. Only PHA coordinators can post system announcements. If you feel you have an important message that is relevant to all service providers please let your coordinator know by using the ‘Contact coordinator’ menu - details of which are described later

• Where a ‘new’ message is posted (and you do not acknowledge reading it) this will be shown to you the next time you log in

• After reading a message click the link: ‘I have read this message, do not show again’.

• Once you have read (and acknowledged) messages click ‘Continue’

• Where there are no ‘New Announcements’ on login the Provider Menu and Specialist List will be displayed

Note : All screens from this point forward will have a description at the top of them to let you see what the screen is for / how to use it.



Reading System Announcements within StopSmokingNI

• New Announcements

On login new announcements are displayed. Read and acknowledge announcements by clicking : “I have read this message, do not show again.”

• View Announcements

To read an announcement, when in the system, select View Announcements (from the Provider menu)

• Having read the announcements, to return to the Provider Dashboard either select either the ‘Back Arrow’ Or ‘Continue’



StopSmokingNI Service Provider and Specialist Statu s

Every client enrols with a Service Provider (e.g. Pharmacy)

However, there may be more than one Smoking Cessation Specialist associated with a Provider. Specialists share a single Provider login and a common client list.

Providers are organisations (e.g. Pharmacy, GP Practice). Specialists are people (e.g. Pharmacists, Doctors, Nurses)

In October 2017, Specialists were added to StopSmokingNI. Now, when a user logs in, they should identify themselves as a specialist. If they do not appear on the list of specialists shown (which will be the case if they have not previously added themselves), they should add themselves to the list.

Benefits of Registering as a Specialist

The benefit of this is that they can then “claim” clients as their own and create a more easily managed client list.

Specialists and Multiple Providers

Where a Specialist works with a number of Providers they can easily associate their Specialist Account with each provider.

The first time a Specialist logs in as a provider (e.g. Provider A above) they should register as a Specialist by adding themselves to the list shown. A unique ‘Specialist Identifier’ will be auto generated for them.

Upon login to any other provider (e.g. Provider B or C above), they must not recreate themselves as a new specialist.

Instead, they should supply the ‘Specialist Identifier’ they were given when they first registered (if they forget this, they should login to the first provider, select themselves from the list shown and read their Specialist Identifier). This will link them across all the Providers they work with and keep a single identity consistent across the whole of the system.

Provider A

Provider B

Provider C

Specialist X



Registering as a New Specialist

• Login (if required read new messages) and continue

• The Specialists list is displayed. Scroll to the end of the list and click the Add New… link

• When registering for the first time do not tick the checkbox, ‘I already have a Specialist Account with another provider’

• Complete the Forename(s), Surname & Email fields

• The ‘Specialist Identifier’ field will not be active

• Select ‘Save’

• If saved, the system will create your Specialist Account and auto generate a unique Specialist Identifer ( i.e. four letters followed by a number)



• If saved, click on your Specialist name from the list. This will activate the Provider Dashboard . Scroll to the bottom of this page to see your: Specialist details: Your Name (Specialist Identifer Code) e.g. Specialist Test - Name (TNHR1)

• Note: Where you select ‘Cancel’ you will still have full access to the StopSmokingNI system during that login period. However, the system will not list you as a Specialist with that provider. Note : This feature may change in future releases (which may make it mandatory to register as a Specialist and select your name on access to the system).



Associating your Specialist Account with another Pr ovider

• Login to the provider you did you originally register with but now wish to associate your Specialist Account with

• Scroll to the end of the Specialists list and click the Add New… link

• To associate a Specialist Account with a provider TICK checkbox: ‘I already have a Specialist Account with another provider’

• Add the ‘Specialist Identifier’ (field activated by the previous step) select ‘Lookup’. This will auto populate the Forename(s) and Surname fields

• Click ‘Save’



Editing Specialist Details

• Login and locate name within

the Specialist list

• Select Edit…

• Make the necessary changes e.g. change Forename(s), Surname and Email address

• Note : Specialist Identifer is a unique code generated which cannot be changed

• If Delete selected clients assigned to that Specialist will still appear on the client list, but as unassigned to a Specialist

• Select ‘Save’ to update



The ‘Provider Dashboard’

This section of the StopSmokingNI system provides you with information about the service. As the system develops further information will be added to help you monitor the service you are delivering.

• Provider Menu

See left hand side of the Provider Dashboard for the Provider menu . System options are accessed via this main menu

• Hyperlinks

Use the hyperlinks to access reference sites e.g.

− ‘Stop Smoking Services Hints and Tips’

− ‘Quality Standards for Stop Smoking Services’ etc.

• From a hyperlink to access StopSmokingNI select the ‘Smoking Cessation Service’ tab

• The provider dashboard will update on an ongoing basis e.g. when you upload client details to the StopSmokingNI system and when you complete their 4 week follow ups.



Contact Coordinator Menu

As required you can leave a message for a Coordinator.

• Select Contact coordinator

• Select New Message (a link above Provider Menu). Unlike the Notice Board – which is viewed by everyone, this is a private message seen by your coordinator and system administration personnel only. A reply to this message will come directly to you.

• Compose your message and select Submit Message. On submit you will see your message (together with your name and a date/time stamp).

• The Reply to your message will be displayed to the right of your text. Your Tobacco Control coordinator / administrator will be in contact with a reply soon.

• Keep checking your ‘Contact Coordinator’ link to see if a reply has been generated.



New Client - Postcode

Once a new client has been added to the system a Specialist can assign the client to their client list.

• Select New Client . Before entering main client details you must provide the client’s Postcode . This will be the first data entry box displayed when you select the ‘New Client’ option.

• To provide good analysis of Client data, the PHA requires reliable postcode information. This is translated into Ward and District for statistical analysis. For this reason, a full postcode (i.e. all six or seven characters) is required. Read the screen for advice on avoiding common mistakes when recording postcode data. If required use the Lookup Postcode here… link

• Select Submit

• Verify the Ward and District details before selecting Continue

• Note : where the Ward/District are incorrect (and Continue not selected) use the ‘Back Arrow’ – top left of screen to return to the postcode input screen



Client Details: Form 1

Once a full postcode has been submitted the main client data entry screen will be displayed.

Completing a Client Details: Form 1

• Client Ref : ensure each client is given a unique reference

• Note : date fields are auto populated (defaulting to the date the client’s record was created). Use the drop down lists provided to change the dates

• See section: ‘Definitions for Clients Details – Form 1’ for information on data required in each field

• Complete the form and select ‘Submit’

• Note : on submission, where mandatory information is missing an error message will be triggered. Make a note of the issue(s) and select ‘OK’. Correct the issue(s) and ‘Submit ’

• From the ‘Adding record..’ dialog select ‘OK’ . On submission the Client Declaration Form is displayed




Once a new client has been added and their record submitted a Client Declaration Summary is available for printing.

• Select ‘Print Declaration’ In consultation with the client, manually complete the ‘Client Declaration Form ’. The Contractor Reference number and the Client Reference number (which are for ‘official use only’) should be entered onto this form by the Specialist, on behalf of the service provider

• Please retain this form in line with your contract for stop smoking services

• Click ‘Return to client list’

• Note : For convenience the most recently added or selected clients link appears on the Provider menu

• Note : This form can also be accessed from the ‘Client Declaration’ link



Viewing-Editing Client Details (Form 1)

If required you can edit client details once submitted.

• If the client reference appears on the Provider menu select this or

• Or Select Client List . This displays the ‘My Clients’ list for the current Specialist. If required ‘Switch Specialist’ to locate the client details to edit

• Click Client Reference to view Client Summary details then

• Click Client Details Form 1 link

• Edit the client’s details and select Submit

• From ‘Record Updated!’ select OK



Assign Clients to a Specialist

Specialists can assign clients to their ‘My Clients’ list. To do this ensure that you are the current Specialist i.e. when you select Client List the ‘My Clients’ table is yours. If not see section: ‘Switch Specialist’ section.

• Select ‘Client List . A table showing ‘My Clients’ is displayed. Note : for New Specialists this will be blank.

• Select ‘Click Here’ to select and assign clients to ‘My Clients’ list. A second table will then show client that could be assigned to ‘My Client’ list. From the 2nd table either select individual clients or ‘Select All’ and click ‘Assign Client’

• Select the Specialist from the drop down list and click ‘Move’

• The selected clients will now appear on the ‘My Client’ list



Moving Clients to another Specialist

• Select Client List

• Select the client(s) to Move then click Move Specialist

• Select a Specialist from the drop down list and click ‘Move’

• Both Specialists client lists are updated (moved from and moved to)



Switch Specialist

• Select ‘Switch Specialist’

• Click on the name of the Specialist to switch to

• The system will be repositioned to the ‘My Client’ list for the chosen Specialist



Follows-Up: Forms 2: 4 weeks Form 3: 52 weeks

Specialists are required to monitor enrolled clients and a complete Form 2 : 4 week follow-up and Form 3: 52 week follow-up.

• Select Client List then the client whose Follow-up Form you wish to update

• Select appropriate link e.g. 4-week Follow-Up (Form 2 ) or 52-week Follow-Up (Form 3 )

• Complete the details and select ‘Submit ’. To help you complete the 4 week and the 52 week forms definitions (of the data fields) are included at the end of the user guide

• Where input errors have been made an ‘Error message’ dialog box will appear. Make a note of the required corrections, select ‘OK’ and return to the form to complete the data as required

Reporting Inaccurate Data Submitted on a Follow-Up Form

• Where you have input the incorrect or inaccurate data you will need to contact your Tobacco Control Coordinator. Please try to avoid this by double checking data entry before submitting the form.



• Where all relevant data has been updated select ‘Submit’. From ‘Record Updated’ select OK

• This will take you to that clients ‘Client Summary’ screen.

• If a payment is due the, ‘Click here to submit a 4 week follow up claim for payment’ button will be activated

• Where selected a claim submission dialog box will appear. Please ensure that you wish to proceed with a claim submission as no further changes can be made once the claim is submitted

• Select ‘OK’ to submit the claim

• You will be returned to the client summary, where confirmation of the claim will be displayed e.g. ‘4-week Follow-up claim for Payment submitted on 15/3/2018’

• Note : 52-week follow-up uses a similar process



Claiming for Payment

Note: The 4 week & 52 week claims process are the s ame.

There are two options for claiming payments:

• From the Client Summary Screen where a ‘Click here to submit a 4 week follow up claim for payment’ or Click here to submit a 52 week follow up claim for payment’ link is activated Or

• From the Provider Menu – Outstanding Claims

Provider Menu - Outstanding Claims

• If you deferred a claim submission then the details of the outstanding claim can be found on ‘Outstanding Claims’

• This will display a list of clients against which claims that can made.

• Select a client from the list to access their ‘Client Summary’ . Select, ‘Click here to submit a 4 week follow up claim for payment’ (same process applies for 52 week)



• If you selected the ‘Click here to submit … link the claim submission dialog box will appear. Please ensure that you wish to proceed with a claim submission as no further changes can be made once the claim is submitted

• Select ‘OK’ to submit the claim

• You will be returned to the client summary, where confirmation of the claim will be displayed e.g. ‘4-week Follow-up claim for Payment submitted on 15/3/2018’



Previous Claims

• A list of submitted claims can be found under the ‘Previous Claims ’ link.

• Once the PHA approves a 4 week or 52 week claim you will see the detail on the previous claims list, along with your pharmacy contractor number or GP practice code, along with the amount you are due.

• Note : The process of claiming for 4 weeks and 52 weeks is the same.



Outstanding Follow Ups

Specialists are required to monitor enrolled clients and a complete Form 2 : 4 week follow-up and Form 3: 52 week follow-up (within the system). The Outstanding follow-up tables will indicate the status for each client.

• Select ‘Outstanding Follow-ups’ . This will display tables of 4 week and 52-week follow-ups

• By clicking on a client reference e.g. ‘Outstanding 4 week follow-ups’ for AS001 the ‘Client Summary’ can be viewed (and if required by updated with follow-up data)

• The system uses ‘Traffic Light’ warning alerts .

o Green : Follow-up not overdue

o Amber : Follow-up Overdue

o Red: Follow-up Overdue (most urgent)



Outstanding Follow-ups – Quality Standards

The process is the same for 52 weeks as it is for 4 weeks.

If the follow up is Red (overdue) then it is your responsibility to contact the client and update their records using the electronic monitoring system. All clients should be followed up as per the Quality Standards for Stop Smoking Services in Northern Ireland i.e.

Quit date set during this month

Latest date for completion January 21 March February 21 April March 21 May April 21 June May 21 July June 21 August July 21 September August 21 October September 21 November October 21 December November 21 January December 21 February



Anonymous Monitoring

The Health and Social Services and Public Safety Department are now required to show equality and fairness in all the services they provide. To help PHA to ensure that this programme is available on an equitable basis please complete the following online equality monitoring questionnaire. This information will be treated in confidence and will not be linked with PART A of the form so that your personal details cannot be identified.

• Select Anonymous Monitoring

• You can either download and print the Equality Monitoring form, manually complete and return by post to the address provided on the form

• Or complete the form Online . link If completing an online form, when you reach to the end select ‘Done’

• If completing online, to return to StopSmokingNI select the ‘Smoking Cessation Services’ Tab



Logout

• Click ‘Logout’ (top right hand corner of screen) Or

• Select Logout from Provider Menu



Possible Problems

For security reasons, this system closes down if screen is left unused for a certain period of time.

If the screen below appears, click on �back button on the toolbar and logout.

You will need to log in again to continue.

� Please note that if this happens whilst inputting Form 1 or follow-up data (Form 2 or 3) and the submit button had not been clicked information will be lost and will have to be re-submitted.



Notes on Completing Stop Smoking Monitoring Forms

Note: All service providers MUST adhere to the Quality Standards for the Delivery of Stop Smoking Services in Northern Ireland

(September 2011)

Important Information

• Clients’ consent must be obtained for these procedures. This should be gathered on the ‘Client Declaration Form.


• Details recorded here regarding the client’s contact information are to be kept at the source. These details will be used for follow-ups at 4 and 52 weeks and also for auditing/probity purposes.

Client Details, Form 1

• Clients should be informed that the data collected on ‘Client Details, Form 1’ will be made available to the Tobacco Control Coordinator for the purposes of local monitoring and evaluation. This is also the case for the 4 week follow up, form 2 and 52 week follow up, form 3.

• Clients should be informed that they will be contacted after 4 weeks and 52 weeks, for follow-up. Clients may be asked to validate their non-smoking status through carbon monoxide (CO) validation at the 4 week follow-up stage.

Definitions on client details form 1:

Initial Assessment Date- This is the date of the first visit by the client.

Date QUIT DATE was set - This is the date that the quit date is set. This will determine what month a client belongs to.

Client Reference Number – Generated by you the provider.

Quit Date – This is the date the client intends to stop smoking. Usually within 2 weeks of the Initial Assessment date.

Employment Status - Chose the most appropriate from the options available:

• Employed - Any person who did paid work in the week before the Initial Assessment.



• Unemployed - A person is defined as unemployed if he or she is not in employment, is available to start work in the next 2 weeks and has either looked for work in the last 4 weeks or is waiting to start a new job. If not available to start work within 2 weeks please refer to the category ‘Economically Inactive’.

• Full time student - A student is a person of any age who has indicated that they are a schoolchild or student in full-time education.

• Training – Those who are taking part in a government or private apprentice or training scheme.

• Retired – Inactive and retired.

• Economically Inactive - Specific categories of Economic Inactivity are: Looking after family/ home, permanently sick/ disabled and a person who is looking for work but is not available to start work within 2 weeks. This category excludes students, retired and homemakers.

• Homemaker – Inactive and looking after the family home/ children.

• Self Employed – The division between employed and self-employed is based on survey respondents’ own assessment of their employment status.

• N/A – Not in education, training or employment or not classified within any of the above categories

Client Postcode – This data will not be stored on the database. It will only be used to identify the ward and district.

Occupation –:

• Managerial / Professional – e.g. accountant, nurse, teacher, manager, designer

• Intermediate – e.g. secretary, personal assistant, office worker, call centre agent, nursery nurse

• Routine and Manual – e.g. HGV driver, van driver, cleaner, porter, labourer, waiter, bar staff.

• Full time student - A student is a person of any age who has indicated that they are a schoolchild or student in full-time education.



• Home carer – looking after the home/ family

• Never worked / long term unemployment

• Sick / disabled and unable to work

• Retired

• Unable to code – not classified within any of the above categories

Gender – The gender of the person should be recorded.

Pregnant at quit date? – Classification of person to either pregnant or not at time of quit date.

Age - The age of the person at the quit date should be recorded.

Type of tobacco – Record the type of tobacco client uses:

• Cigarette

• Cigar

• Pipe

• N/A

Average smoked daily: weekdays - Average number of cigarettes smoked daily during the weekdays. (Weekday refers to Monday to Friday inclusive)

Average smoked daily: weekend - Average number of cigarettes smoked daily during the weekend. (Weekend refers to Saturday and Sunday)

Client entitled to free prescriptions – From 1 April 2010, prescriptions have been free of charge in Northern Ireland. This may be subject to change.

Has the client previously participated in this prog ramme? – A minimum of 6 months must elapse before a client who has previously participated in a specialist stop smoking programme can be reregistered with a specialist stop smoking programme.

How did you hear about the services? – Select one option from the drop down menu that details how the client found out about the stop smoking service.

Reason for Quitting – Record the reason that best fits why the client has decided to quit smoking.



Has the client been given an equality monitoring fo rm – Record if you have given the client an equality monitoring form. If you are an administrator entering data onto the elite system for the stop smoking specialist please try to establish if an equality monitoring form was issued. If you cannot establish this then record it as ‘unknown’.

Is this a workplace referral? – If the client has been referred to you by their workplace or by a specialist stop smoking adviser providing a service within a workplace record client as a workplace referral.

Has the client tried to give up smoking using any o ther methods within the last 3 years? – Record any ways the client has attempted to give up in the last 3 years. Hint: You can use "Ctrl" key + mouse click to select more than one option.



4-Week Follow-up, Form 2

• The time within which the follow-up must be completed is 6 weeks after the quit date.

• Clients should either be seen in person or contacted by telephone.

• Up to 3 attempts should be made to reach the client by telephone (if contact by telephone is not feasible a letter should be sent).

Definitions on 4-Week Follow-up Form 2:

(Additional to Client Details Form 1 above)

Was follow-up completed? – Indicate whether client has attended follow-up (either in person or by telephone).

Date follow-up completed – Indicate date 4-week follow-up was completed.

Date of last cigarette – This is the date of the last cigarette smoked by the client. If necessary, the date entered should be a ‘best guess’ of the exact date on which the client last smoked.

Has client quit smoking? (Self Report) – Indicate here whether the client has quit smoking based on their self-report. A client should be counted as having successfully quit smoking if he/she has not smoked at all since 2 weeks after the quit date.

(E.g. if quit date were a Wednesday, 2 weeks after the quit date would be the Wednesday two weeks later).

The reason for adopting the “2 weeks after quit date” definition is to allow a period of “grace” in recognition of the fact that some smokers initially struggle but then manage to quit.

Has CO validation been carried out? – Indicate whether the CO validation test has been carried out on the client at the 4-week follow-up point

If YES indicate if CO validation test verifies no-smoking status.

If NO indicate reason and identify if client has reduced smoking intake and also if client intends to rejoin the programme.

With regard to follow-up – Indicate which form of action was taken in order to try and contact the client at the 4-week follow-up point.



52-Week Follow-up, Form 3

Note: ONLY clients who had quit at 4 week follow-up are to be followed up at 52 weeks

• All clients who self-reported as having quit smoking at 4-week follow-up should be followed up again at 52 weeks.

• The same procedures as for the 4-week follow-up should be used to contact clients at 52 weeks.

• A client should be regarded as a non-smoker at 52 weeks if they have not smoked since 2 weeks after their original quit date.

Definitions on 52-Week Follow-up Form 3:

Only those who successfully quit at 4-week follow-up should be followed up at 52-weeks

Date follow-up completed – Indicate date 52-week follow-up was completed.

Date of last cigarette – This is the date of the last cigarette smoked by the client.

Has client quit smoking? (Self-Report) – Indicate here whether the client has quit smoking based on their self-report. A client should be counted as having successfully quit smoking if he/she has not smoked at all since at least 50 weeks after the quit date. This accounts for two weeks after quit when the client is allowed a period of “grace” in recognition of the fact that some smokers initially struggle but then manage to quit.

Has CO validation been carried out? – Indicate whether the CO validation test has been carried out on the client at the 52-week follow-up point. If YES indicate if CO validation test verifies no-smoking status.

If NO indicate reason and identify if client has reduced smoking intake and also if client intends to rejoin the programme.

With regard to follow-up – Indicate which form of action was taken in order to try and contact the client at the 52-week follow-up point.



Part B (Equality Monitoring)

• This section is to be completed by the client confidentially and returned to the PHA either in paper form (to the respective local office – details on Page 3). The service provider can upload the detail using the electronic system if they wish, however, this is not a requirement.

Definitions on Part B, Equality monitoring:

Ethnic Group - The Ethnic Group question records each person's perceived ethnic group and cultural background.

Religion - This information is only used in the derivation of Community Background, please record the current religion. Missing answers for the Religion variable are not imputed so the classifications include a 'not known' category.

Are you responsible for the care of a dependent … – Record whether any of the listed three possible categories apply. The definition of a dependant in this instance is a child, adult with problems due to old age or someone with long-term physical/mental ill health or disability living in the same household. In the case of illness, injury or breakdown of care arrangements, a dependant can also include someone who relies on you for assistance, but may not live with you.

Do you consider yourself to be disabled? - A disabled person as someone with "a physical or mental impairment, which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities."

The Disability Discrimination Act (DDA) protects disabled people. The Act sets out the circumstances in which a person is "disabled". It says you are disabled if you have:

• a mental or physical impairment • this has an adverse effect on your ability to carry out normal

day-to-day activities • the adverse effect is substantial • the adverse effect is long-term (meaning it has lasted for 12

months, or is likely to last for more than 12 months or for the rest of your life).

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